Patients aren’t the only ones who worry that their hospital’s emergency room (ER) is too busy to deliver reliable, prompt care. A majority of hospital leaders worry about the same thing. In a recent survey conducted by the American College of Emergency Physicians, most administrators named overcrowding in the ER as one of their top five management concerns.
Improving patient flow in the emergency department is a top priority in hospitals across the country. After studies are done, hospitals are finding that implementing patient flow improvements has led to greater efficiency, higher patient and staff satisfaction, and cost savings.
Expanding the capacity of the ER to handle more patients is often identified as the obvious solution. But one hospital did just the opposite. They closed some rooms and reduced the nurse/patient ratio from 1:4 or 1:5 to 1:3.
This allowed the nurses to work more efficiently. With four or more patients, the nurses were too overloaded and couldn’t move patients out quickly enough. When seeing fewer patients each, they ended up seeing more overall and drastically cut their patient turnaround times.
These nurses also had more time to talk with patients and educate them. They could work more closely with the physicians, guiding them toward the most acutely emergent patients first, and helping them with the prompt disposition of patients.
Experts also say that simply enlarging the ER ignores the underlying factors responsible for the logjam: inadequate systems to manage the flow of patients throughout the hospital.
The hospital that reduced its nurse/patient ratio made the same discovery. Once patients started moving more quickly through the ER, the ER staff found that there were bed crunch issues in other areas of the hospital. They couldn’t place patients in medical/surgical or ICU beds as fast as they needed to. It was time to identify the next blockage.
This turned out to be part of the process involved in transferring patients. Usually, when a patient needed to be transferred, the ER or recovery room nurse would call the nurse on the admitting floor to give a report about the patient. If the second nurse wasn’t available to come to the phone, the patient would have to wait until the nurses were able to talk to each other.
The flow team created a simple form and a new process to eliminate this delay. The ER nurse now writes a brief summary of the patient’s diagnosis on the form and faxes it, along with other notes, to the admitting floor. The ER nurse calls the nursing station on that floor to let them know the fax is coming. The patient leaves the ER 15 minutes after the report is faxed, which gives the floor nurse time to review it and call with any questions before the patient is brought up.
Some solutions to improving patient flow seem counterintuitive. Others seem like common sense. The Institute for Healthcare Improvement offers a vast collection of research, tools and resources to help improve patient flow in your organization. Taking the time to analyze your current situation and identifying areas of improvement is the first step toward optimizing patient flow.
Do you have any thoughts or questions to share? Please contact Morgan Hunter HealthSearch today.